Alexander Soldatov1, Christoph A J von Klot2, Daniel Walacides1, Thorsten Derlin3, Frank M Bengel3, Tobias L Ross3, Hans-Jürgen Wester4, Katja Derlin5, Markus A Kuczyk2, Hans Christiansen1, Christoph Henkenberens6. 1. Department of Radiation Oncology, Hannover Medical School, Hannover, Germany. 2. Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany. 3. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany. 4. Pharmaceutical Radiochemistry, Technical University Munich, Garching, Germany. 5. Department of Radiology, Hannover Medical School, Hannover, Germany. 6. Department of Radiation Oncology, Hannover Medical School, Hannover, Germany. Electronic address: henkenberens.christoph@mh-hannover.de.
Abstract
PURPOSE: To determine the patterns of progression after 68Ga prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET)/computed tomography (CT)-guided radiation therapy (RT) for recurrent oligometastatic prostate cancer (PCa). METHODS AND MATERIALS: One hundred and eight patients with increased prostate-specific antigen levels, who received 68Ga-PSMA-ligand PET/CT-guided RT for recurrent oligometastatic disease after primary therapy for PCa were included. The biochemical progression-free survival and distant disease-free survival after PSMA-ligand PET/CT-guided RT were determined. The patterns of progression were determined using renewed 68Ga-PSMA-ligand PET/CT in patients with biochemical progression and compared with the clinical target volume of the 68Ga-PSMA-ligand PET/CT-guided RT. The frequency of infield and outfield relapses was recorded. RESULTS: A total of 97.2% (105 of 108) of patients showed a decrease in prostate-specific antigen levels after RT and were classified as biochemical responders. After the median follow-up of 18 months, 43.5% (47 of 108) of the patients experienced biochemical progression, resulting in an estimated biochemical progression-free survival of 16 months. Renewed 68Ga-PSMA-ligand PET/CT allowed localization of recurrent disease in 91.7% (33 of 36) of patients. Analysis of the patterns of progression resulted in a cumulative infield relapse rate of 12.1% (4 of 33) and a cumulative outfield relapse rate of 87.9% (29 of 33). The resultant median disease-free survival was 11 months. In terms of the pattern of progression, we observed a shift in the pattern of metastases toward skeletal involvement and distant lymph node metastases. Of these patients, 45.5% (15 of 33) were treated with further RT to delay initiation or escalation of systemic therapies. CONCLUSION: PSMA-ligand PET/CT-guided RT for relapsed PCa with limited tumor burden allowed individualization of treatment approaches, provided effective local control, and resulted in considerably prolonged biochemical progression-free survival. As indicated by the PSMA-ligand PET/CT-based patterns of progression, repeated PET/CT-guided RT may represent a treatment option in well-selected patients with relapse after RT for oligometastatic disease.
PURPOSE: To determine the patterns of progression after 68Ga prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET)/computed tomography (CT)-guided radiation therapy (RT) for recurrent oligometastatic prostate cancer (PCa). METHODS AND MATERIALS: One hundred and eight patients with increased prostate-specific antigen levels, who received 68Ga-PSMA-ligand PET/CT-guided RT for recurrent oligometastatic disease after primary therapy for PCa were included. The biochemical progression-free survival and distant disease-free survival after PSMA-ligand PET/CT-guided RT were determined. The patterns of progression were determined using renewed 68Ga-PSMA-ligand PET/CT in patients with biochemical progression and compared with the clinical target volume of the 68Ga-PSMA-ligand PET/CT-guided RT. The frequency of infield and outfield relapses was recorded. RESULTS: A total of 97.2% (105 of 108) of patients showed a decrease in prostate-specific antigen levels after RT and were classified as biochemical responders. After the median follow-up of 18 months, 43.5% (47 of 108) of the patients experienced biochemical progression, resulting in an estimated biochemical progression-free survival of 16 months. Renewed 68Ga-PSMA-ligand PET/CT allowed localization of recurrent disease in 91.7% (33 of 36) of patients. Analysis of the patterns of progression resulted in a cumulative infield relapse rate of 12.1% (4 of 33) and a cumulative outfield relapse rate of 87.9% (29 of 33). The resultant median disease-free survival was 11 months. In terms of the pattern of progression, we observed a shift in the pattern of metastases toward skeletal involvement and distant lymph node metastases. Of these patients, 45.5% (15 of 33) were treated with further RT to delay initiation or escalation of systemic therapies. CONCLUSION:PSMA-ligand PET/CT-guided RT for relapsed PCa with limited tumor burden allowed individualization of treatment approaches, provided effective local control, and resulted in considerably prolonged biochemical progression-free survival. As indicated by the PSMA-ligand PET/CT-based patterns of progression, repeated PET/CT-guided RT may represent a treatment option in well-selected patients with relapse after RT for oligometastatic disease.
Authors: Ann-Kathrin Oehus; Stephanie G C Kroeze; Nina-Sophie Schmidt-Hegemann; Marco M E Vogel; Simon Kirste; Jessica Becker; Irene A Burger; Thorsten Derlin; Peter Bartenstein; Matthias Eiber; Michael Mix; Christian la Fougère; Claus Belka; Stephanie E Combs; Anca-Ligia Grosu; Arndt-Christian Müller; Matthias Guckenberger; Hans Christiansen; Christoph Henkenberens Journal: BMC Cancer Date: 2020-04-29 Impact factor: 4.430
Authors: Hamza Hasan; Matthew P Deek; Ryan Phillips; Robert F Hobbs; Reem Malek; Noura Radwan; Ana P Kiess; Shirl Dipasquale; James Huang; Terry Caldwell; Jessica Leitzel; Danielle Wendler; Hao Wang; Elizabeth Thompson; Jonathan Powell; Sara Dudley; Curtiland Deville; Stephen C Greco; Daniel Y Song; Theodore L DeWeese; Michael A Gorin; Steven P Rowe; Sam Denmeade; Mark Markowski; Emmanuel S Antonarakis; Michael A Carducci; Mario A Eisenberger; Martin G Pomper; Kenneth J Pienta; Channing J Paller; Phuoc T Tran Journal: BMC Cancer Date: 2020-06-01 Impact factor: 4.430
Authors: Ryan Phillips; William Yue Shi; Matthew Deek; Noura Radwan; Su Jin Lim; Emmanuel S Antonarakis; Steven P Rowe; Ashley E Ross; Michael A Gorin; Curtiland Deville; Stephen C Greco; Hailun Wang; Samuel R Denmeade; Channing J Paller; Shirl Dipasquale; Theodore L DeWeese; Daniel Y Song; Hao Wang; Michael A Carducci; Kenneth J Pienta; Martin G Pomper; Adam P Dicker; Mario A Eisenberger; Ash A Alizadeh; Maximilian Diehn; Phuoc T Tran Journal: JAMA Oncol Date: 2020-05-01 Impact factor: 31.777